The Diagnostic and Statistical Manual of Mental Health (DSM) has recently been revised and the newest edition, DSM-V, includes some new diagnoses. One of the new diagnoses is Disruptive Mood Dysregulation Disorder or DMDD. A study conducted by a professor at Fairleigh Dickinson University in New Jersey found that this newly outlined disorder may be more prevalent than was realized, especially among young patients with bipolar disorder.
Dr. Pogge of Fairleigh Dickinson studied over 1,500 13-17 year old patients in private hospital care who were admitted for mental health treatment. The study spanned a two-year time frame. Close to 1,400 of the patients admitted were identified by clinicians as suffering from moderate depression. Serious problems with explosiveness and hostility were evident in 368 of the teens.
During admission 259 patients were identified as suffering from bipolar disorder. A handful of patients were diagnosed as bipolar mania (high energy/euphoric), bipolar depression and bipolar mixed. The research team paid particular attention to 174 patients with moderate depression and serious hostility but who showed none of the manic symptoms of euphoria normally associated with bipolar disorder at the time they entered treatment.
Disruptive Mood Dysregulation Disorder
Disruptive mood dysregulation disorder is characterized by strong outbursts of anger in addition to a history of depression and irritability. Aggressiveness and angry outbursts commonly predicate the teen’s admission into hospital care for treatment.
The majority of patients (63 percent) did not match the guidelines for DMDD. But those who did often had to be isolated or at least restrained more often and for longer periods than the other patients with bipolar disorder. The teen patients who met the diagnosis criteria for DMDD also tended to require more time in the hospital. These patients also left the hospital with higher global pathology (GAF scores).
In this study 37 percent of the 175 teens being hospitalized for bipolar disorder were found to meet the criteria for the condition DMDD although 96 percent of the teens had been diagnosed with bipolar I disorder upon hospital admittance. Dr. Pogge suggested that many of the bipolar disorder I cases which had fallen under the ‘not otherwise specified’ category may, in fact, be instances of disruptive mood dysregulation disorder.
Misdiagnosis Of Bipolar Disorder
It could be that teenagers are being misdiagnosed with bipolar when they actually are suffering from DMDD. On the other hand, Dr. Pogge pointed out, it could well be that teens with bipolar I disorder have a significant risk for comorbidity with the new DMDD. More study is needed to be sure, but it was suggested that there are a greater number of teens with DMDD needing inpatient treatment than was previously realized.
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